House GOP Confident Ahead of Health Care Vote

House Republicans say they have the votes to pass a bill on Thursday that would repeal key parts of the Affordable Care Act, as more GOP lawmakers lend their support to the measure after previously being undecided.

The vote, scheduled for Thursday afternoon, comes almost six weeks after Republican leaders pulled an earlier version of the legislation, dubbed the American Health Care Act, shortly before a planned House vote. That setback led to weeks of negotiations to gain enough backing for the bill and help Republicans deliver on years of campaign promises to repeal Obamacare.

GOP lawmakers say their bill is urgently needed to improve the individual insurance market, particularly after recent decisions by health insurers not to offer plans next year in Iowa and Virginia.

“We can talk about anything you want to talk about, but someone with pre-existing conditions or otherwise doesn’t have insurance if there’s no insurance company to provide insurance,” Rep. Chris Collins (R-N.Y.) told reporters Thursday following a meeting with fellow House Republicans.

The measure would repeal the ACA’s taxes, the individual and employer mandates and the subsidies that help lower-income people afford out-of-pocket health care costs. Instead of subsidies based on income and location to help people afford monthly premiums, the bill relies on age-based tax credits that would exclude the wealthiest.

The legislation also would restructure Medicaid, the federal program for 74 million people that GOP leaders call a major entitlement reform. Federal money that goes toward Medicaid would be would be capped per enrollee, and states would get new flexibility to lower costs. Furthermore, the measure would also address the ACA’s Medicaid expansion and bar states from enrolling new individuals in the expansion program beginning in 2020.

The House Rules Committee on Wednesday considered two amendments to the bill. One, from Rep. Tom MacArthur (R-N.J.), would allow states to apply for an exemption from the ACA’s essential health benefits or community rating provisions if they participate in a high-risk pool or reinsurance program for people with pre-existing conditions. An earlier amendment to the legislation would add $15 billion over roughly 10 years to create a federal high-risk pool, which states could participate in, for the sickest patients.

Another amendment, offered by Rep. Fred Upton (R-Mich.), would provide an additional $8 billion over five years for states with waivers to help the sickest Americans afford higher insurance premiums and other health costs.

Rep. Brian Mast (R-Fla.), a freshman lawmaker who’s a double amputee, said the extra funding for risk pools helped persuade him to support the measure after he was worried about the impact on people with pre-existing health conditions.

Still, many policy analysts say the funding amount may not be adequate to cover the needs of sick Americans.

“Given the amount of funding in the bill, the program can only afford a few small states to opt into medical underwriting,” Caroline Pearson, a senior vice president at consulting firm Avalere, said in an analysis Thursday. “If any large states receive a waiver, many chronically ill individuals could be left without access to insurance.”

The legislation faces fierce opposition from the health care industry, particularly hospitals and patient advocacy groups; insurers have been less vocal.

“Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill – that millions of Americans will lose their health insurance as a direct result of this proposal,” the American Medical Association said in a statement Wednesday.

Thursday’s vote was scheduled despite any analysis of the revised legislation by the nonpartisan Congressional Budget Office, meaning lawmakers don’t have an independent estimate of its effects and cost. In March, the CBO estimated that 24 million fewer people would have insurance under a prior version of the AHCA, though premiums would fall by 2026.

While House Republicans are moving forward without that CBO analysis, it will be necessary in the Senate, where the bill is almost certain to change. Because Republicans are using budget reconciliation to pass the vote, an updated CBO score will be necessary for the Senate parliamentarian to determine whether the measure abides by the Byrd rule.

House Minority Leader Nancy Pelosi criticized Republicans for taking up the vote without the CBO score, and said the legislation’s supporters are likely to face election-year challenges.

“This is a scar they will carry,” the California Democrat said before the vote. “The members of the House Republican caucus will be identified by the worst aspects of the bill they pass.”

Eli Yokley contributed.